ILPQC MNO-Neo Teams Call: Safe Discharge Planning and Linking …€¦ · 18/03/2019 · not...

ILPQC MNO-Neo Teams Call:Safe Discharge Planning and

Linking to Community Resources

March 18th, 2019

Call Overview

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• ILPQC Updates• MNO‐Data Review• Safe Discharge Planning and Linking to Community Resources

• Team Talks• NorthShore University HealthSystem Evanston Hospital• SSM Health Cardinal Glennon Hospital, St. Louis

• QI Corner• Next Steps for teams

MNO Neonatal Key Drivers

Aims• Decrease

pharmacologic treatment in opioid exposed neonates to 20%

• Increase breastfeeding rates in opioid exposed neonates at discharge to 70%

• Increase safe and optimized discharge plans in opioid exposed neonates to 95%

Primary Drivers Secondary Drivers Change Ideas

Identification and Assessment of OENs

Treatment

Safe Discharge

Strengthen Family/Care Team Relationships

Improve pre‐delivery planning

Standardize identification, assessment, and monitoring of OENs

Provide Family Education

Improve infant nutrition and breastfeeding

Optimize non‐pharmacologic care

Standardize pharmacologic treatment

Coordinate safe discharge

Non‐judgmental support

Prenatal pediatric consultation

Social work consultation

Toxicology testing

Assessment tools

Feeding guidelines

Non‐pharmacologic care guidelines

Pharmacologic treatment guidelines

Safe discharge guidelines

DCFS

MNO-Neo in 2019

Key Strategies

• Prenatal Consult• Stigma/Bias• Toxicology Testing• Assessment of OENs

Strategies to review in 2019

• Non‐Pharm Care• Pharm treatment• Safe Discharge Planning

Work towards

goals in 2019

• Optimize non‐pharm care

• Reduce pharm treatment

• Increase safe discharge plans

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Covered in 2018

How do we begin to make progress?

MNO-Neo:Making Change Happen

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Key QI Strategies

Implement standardized identification of OENwith OB

Standardize assessment of NAS signs and symptoms for OENs

Implement non‐pharmacologic bundle

Establish feeding guidelines for OENs including breastfeeding eligibility

Standardized pharmacologic treatment protocol

Standardize provider training ‐ stigma & bias, OEN protocolStandardize patient education

Implement standardized safe discharge planning

Complete and document prenatal

consult

Obtain toxicology testing, perform standardized

assessment of NAS signs & symptoms for OENs

Initiate Non-pharmacologic treatment, document non-

pharm care checklist in medical record

Determine maternal eligibility to breastfeed, encourage

breastfeeding and determine/provide

appropriate nutrition support

After optimization of non-pharmacologic care, initiate

pharmacologic treatment protocol as needed

MNO-Neo OEN Protocol

Activating the OEN protocol for every OEN

Complete and document safe discharge plan

Aims:• Decrease pharmacologic treatment in opioid‐exposed

newborns with NAS to 20%• Increase safe and optimized discharge plans in opioid‐exposed

newborns to 95%• Increase breastfeeding rates in opioid‐exposed newborns at discharge

to 70%

Measures:• Percent of opioid‐exposed newborns receiving a toxicology

screen (urine/cord/meconium) • Percent of opioid‐exposed newborns requiring pharmacologic

therapy for NAS• Number of days of pharmacologic treatment for NAS• Percent of mothers and newborns rooming together during

infant hospitalization• Percent of opioid‐exposed newborns receiving maternal breast

milk at neonatal discharge• Percent of opioid‐exposed newborns discharged with plan of

safe care in place• Average length of stay for opioid‐exposed newborns

Mothers and Newborns affectedby Opioids- Neo Initiative

MNO-Neo Patient-LevelData Entry Status

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Monthly Process/Outcome

Total Records # Teams with Patient Level Data Reported

# Teams with No Newborns to Report

# Teams Reporting

Baseline 276 62 12 74

July 2018 45 32 36 68

August 2018 88 39 34 73

September 2018 65 31 38 69

October 2018 64 31 34 65

November 2018 51 26 38 64

December 2018 53 28 26 54

January 2019 45 27 30 57

February 2019 28 18 18 36

MNO Neo Structure MeasuresData Entry Status

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MonthlyStructure Measures

# Teams with Data

Baseline 58

July 2018 49

August 2018 49

September 2018 51

October 2018 47

November 2018 40

December 2018 42

January 2019 42

February 2019 24

Structure measures are important tools to review with your team monthly to monitor your progress towards sustainable improvement

EVERYONE whether you see 1 to 100 infants / year your team can structure processes for success!

MNO-Neo Structure Measures:Standardized Prenatal Consult

3% 4% 8% 12% 17% 15% 19% 28% 30%25%46% 47%

56%55% 65% 60%

53% 52%72%

50% 45%33% 28% 20% 21% 19% 17%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Baseline(October ‐December2017)

Jul‐18 Aug‐18 Sep‐18 Oct‐18 Nov‐18 Dec‐18 Jan‐19 Feb‐19

Percent of hospitals that have implemented standardized protocols/guidelines for Prenatal Consult

All Hospitals, 2018‐2019

In Place Working On It Have Not Started

MNO-Neo Structure Measures:Standardized Non-Pharm Care

3% 8% 14% 17% 18% 24% 23%35% 39%32%

50% 47%57% 56%

57% 58%51%

52%65%42% 39%

26% 27% 19% 19% 14% 9%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%



Percent of hospitals that have implemented standardized protocols/guidelines for Non‐Pharmacologic Care



MNO-Neo Structure Measures:Standardized Pharm Treatment

33% 42% 43% 44% 36% 35% 40% 44% 43%

17%

27% 29% 33% 42% 48% 42%44% 43%

50%31% 27% 23% 22% 18% 19% 12% 13%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%



Percent of hospitals that have Implemented Standardized Pharmacologic Guidelines for OENs



MNO-Neo Structure Measures:Standardized Discharge Planning

7%17% 20% 23% 13% 12% 14%

23% 22%

33%

43% 45% 49% 60% 67% 65%53% 65%

60%40% 35% 28% 27% 21% 21% 14% 13%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%



Percent of hospitals that have implemented standardized protocols/guidelines for Safe Discharge Planning

All Hospitals, 2018


MNO-Neo Process Measures:OENs Receiving Toxicology Testing

90%93%

88%94%

97% 92% 98%

88%92%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Baseline (2017) Jul‐18 Aug‐18 Sep‐18 Oct‐18 Nov‐18 Dec‐18 Jan‐19 Feb‐19

ILPQC MNO OB/Neo InitaitivePercent of OENs (≥35 weeks) receiving a toxicology test (urine, cord,

meconium) for NASAll Hospitals, 2018‐2019

% of OENs

MNO-Neo Process Measures:Rooming In During Infant Hospitalization

63%69% 67% 65% 63%

70%

57%66% 69%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Baseline Jul‐18 Aug‐18 Sep‐18 Oct‐18 Nov‐18 Dec‐18 Jan‐19 Feb‐19

ILPQC MNO‐OB/Neo Initiative:Percent of mothers with OUD/OENs (>35 weeks) who roomed together during infant

hospitalizationAll Hospitals, 2018‐2019

All Hospitals

MNO-Neo Outcome Measures:Eligible OENs Receiving Maternal Breast Milk at Infant Discharge

59% 56%

74% 76% 69%

52%

48%

67%

42%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


ILPQC MNO OB/Neo InitaitivePercent of Eligible OENs (≥35 weeks) Receiving Maternal Breastmilk

at Infant DischargeAll Hospitals, 2018

% of OENs Goal

MNO-Neo Outcome Measures:OENs Requiring Pharmacologic Treatment for NAS

33%

16%19% 21%

32%29%

32%

43%

38%

51%

29% 32% 33%

44% 41%47%

56%48%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


ILPQC MNO OB/Neo InitaitivePercent of OENs (≥35 weeks) requiring pharmacologic treatment for

NASAll Hospitals, 2018

% of all OENs % of OENs with NAS Symptoms Goal

Median Days of Pharmacologic Treatment for OENs (≥35 weeks ) with NAS symptoms

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0

10

20

30

40

50

60

Baseline(2017)

Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19

ILPQC MNO-Neo: Median Number of Days of Pharmacologic Treatment for OENs (≥35 weeks) with NAS

symptoms during infant hospitalizationAll Hospitals, 2018-2019

MNO-Neo Outcome Measures:OENs Discharged with a Safe Discharge Plan

38% 33%

49%54% 55%

39%47% 45%

59%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


ILPQC MNO OB/Neo InitaitivePercent of OENs (≥35 weeks) Discharged with a Safe Discharge Plan Made in Partnership with Family, Hospital, and Community PCP

All Hospitals, 2018

% of OENs Goal

MNO-Neo Outcome Measures:Average Length of Stay for OENs

0

5

10

15

20

25

30

35

40

45

50

Baseline(2017)

Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19

ILPQC MNO-Neo: Median Length of Stay (LOS) for All OENs with NAS Symptoms (≥35 weeks)

All Hospitals, 2018-2019

MNO Data Sharing Update

As with the Maternal Hypertension Initiative, ILPQC participates in the National ACOG Alliance for Innovation on Maternal Health (AIM) program. Our participation in this program allows for statewide

comparisons of quality data across participating AIM states. For MNO, we will share aggregate de‐identified hospital‐level data (we will not share hospital name/ID and AIM will not be able to identify individual hospitals; patient level data will not be shared). MNO data will be

shared with AIM by default (no DUA required). If you do not wish for us to share your hospital’s de‐identified data please let us know in writing by March 31 via an email from the project lead and nurse lead and/or physician lead. As in the past, if your hospital would like a DUA with ILPQC, please contact us at [email protected] for a template. ILPQC does

not require DUAs.

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Safe Discharge Planning and Linking to Community Resources

Importance of Safe Discharge PlanningDischarge planning should ideally begin during the antenatal period. Safe discharge will focus on child vulnerability, adult protective capabilities, and safety factors. If withdrawal signs or symptoms are minimal, then a comprehensive discharge plan that addresses maternal substance use disorder treatment, a safe environment for both mother and baby, and parenting and community supports is essential.

A Safe Discharge Plan made in partnership with the family, hospital, and the community primary care provider includes these key components:1. ILPQC MNO‐Neo “Coordinating a Safe Discharge” Bundle Reviewed with

family2. MD to MD Communication3. DCFS Clearance/Coordination4. Official Referral to Early Intervention (IL Child and Family Connections)

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Safe Discharge Planning:4 Key ComponentsA Safe Discharge Plan made in partnership with the family, hospital, and the community primary care provider includes these key components:1. ILPQC MNO‐Neo “Coordinating a Safe Discharge”

Bundle Reviewed with family2. MD to MD Communication3. DCFS Clearance/Coordination4. Official Referral to Early Intervention (IL Child and

Family Connections)

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1. ILPQC MNO-Neo “Coordinating a Safe Discharge” Bundle Reviewed with family

ILPQC MNO-NeoCoordinating Safe Discharge Bundle

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• This bundle of safe discharge criteria should be completed for every family in conjunction with the hospital and community primary care provider before infant discharge: http://www.ilpqc.org/docs/toolkits/MNO‐Neo/ILPQC_Coordinating‐Safe‐Discharge.pdf

ILPQC MNO-NeoCoordinating Safe Discharge Bundle (cont.)

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4‐7 days of inpatient monitoring for infants who do not require pharmacotherapy

48 hours of inpatient monitoring after pharmacotherapy for infants who require pharmacotherapy

The infant should feed well and gain weight over two consecutive days

Consultation with social work completed *Coordination and clearance with Illinois Department of

Children and Family Services (DCFS) completed *Communication and coordination with primary care

provider completedMedication dispending schedule and demonstration of ability

to dose the infant, if applicable


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Developmental follow‐up appointment scheduled *Referral to Early Intervention completedWomen, Infants, and Children (WIC) appointment scheduled,

if applicable Home nurse visit scheduled including weight check scheduled

for 1‐3 days following discharge, if applicable Additional follow up appointments scheduled, including

physical or occupational therapy Hepatitis B/Hepatitis C/HIV exposed infants – Pediatric

infectious disease appointment scheduled or if preference is to follow infant in primary care, please refer to 2018 American Academy of Pediatrics Red Book for current recommendations.


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Education provided regarding: Importance and benefits of breastfeeding, unless contraindicated Early Intervention APORS Increased risk of visual problems including strabismus Developmental follow‐up Safe sleep practice Non‐accidental trauma CPR

Neonatal Abstinence Syndrome: What you need to know‐ A Guide for Families (booklet) What to expect at home How to soothe the baby What to do if caregivers are stressed or need a break

2. MD to MD Communication

MD to MD Communication

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*Communication and coordination with primary care provider completedDiscussion of medical and social information, including infant custody

Description of hospital coursePlan for outpatient medication wean, if applicableHeightened need for vision screening for refractive errors/strabismus

Appointment scheduled for 24‐48 hours after discharge

3. DCFS Coordination/Clearance

DCFS Coordination/Clearance:What You Should Know

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• Illinois Department of Children & Family Services (DCFS) Website: www2.illinois.gov/dcfs

• DCFS Info and Assistance: 800‐232‐3798 / 217‐524‐2029

• To report suspected child abuse or neglect: 1‐800‐25‐ABUSE (252‐2873)

• Mandated Reporter Information: Illinois state law requires that most professionals in education, health care, law enforcement and social work report suspected neglect or abuse. Any mandated reporter having reasonable cause to believe a child known to them in their professional or official capacity may be an abused child or a neglected child shall immediately report or cause a report to be made to the Department.

ILPQC is currently creating a “DCFS Quick Guide for

Hospital Teams” to provide guidance on coordinating

with DCFS

DCFS Coordination/Clearance:What You Should Know

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Linking mothers to Medication Assisted Treatment (MAT) / Behavioral Health Counseling / Recovery Services prenatally or by

delivery admission is a key step in safe discharge planning

• Abused and Neglected Child Reporting Act (325 ILCS 5/): Neglected child means any child who is a newborn infant whose blood, urine, or meconium contains any amount of a controlled substance as defined in subsection (f) of Section 102 of the Illinois Controlled Substances Act or a metabolite thereof, with the exception of a controlled substance or metabolite thereof whose presence in the newborn infant is the result of medical treatment administered to the mother or the newborn infant.

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DCFS Coordination/Clearance:Importance of Plan of Safe Care

• CARA‐ Comprehensive Addiction and Recovery Act 2016– Amended 2010 CAPTA (Child Abuse Prevention and Treatment Act

– Focused on prevention and treatment.– Specified data to be reported to by the States– Required Plan of Safe Care to include needs of both the infant and family/caregiver

– Specified increased monitoring and oversight by States to ensure that Plans of Safe Care are implemented and families have access to appropriate services

https://www.acf.hhs.gov/sites/default/files/cb/im1605.pdf

DCFS Coordination/Clearance:Making a Call to DCFS

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• When Does a Call to the Hotline Need to Be Made? – IF a child is born with positive toxicology test (blood, urine, or meconium contains any amount of a

controlled substance as defined in the Illinois Controlled Substances Act) that is NOT the result of a prescribed medical treatment administered to the mother or the newborn infant CALL DCFS

– IFmother has positive toxicology test for controlled substance that is NOT prescribed CALL DCFS– IFmother or child has positive toxicology test for controlled substance that is NOT prescribed and

children are in the home CALL DCFS• What Happens When a Call is Made?

– MCNRT – No report taken– Report – Evidence provided meets criteria (victim is under 18)– Child Welfare Referral – “Gentler” knock at door, linkage to community resource (caller can request)

• What Happens After a Call is Made?– Investigator will call to confirm what was reported– Investigator comes to hospital to interview and assess safety– Determination if protective custody and foster care is needed– Determination if infant/other children can remain in the home with supports– Plan of safe care/discharge planning *Refer to your hospital’s social services department for specific

policies and procedures

DCFS Coordination/Clearance:About DCFS Protective Custody

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• DCFS Protective Custody of Substance Exposed Newborns:– Child Protection Specialists shall not request that hospitals postpone discharge of infants who are medically ready for discharge.

– Child Protection Specialists shall not take substance exposed infants into protective custody or accept a voluntary placement agreement just because the mother used illegal drugs during her pregnancy.

– For protective custody of a substance exposed infant to be taken there must be other circumstances present that clearly demonstrate that leaving the infant in the care and custody of the mother presents an imminent danger to the infant’s life or well‐being.

DCFS Coordination/Clearance:DCFS Resources

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• Agency and Community Resources for Mothers and Infants Affected by Opioids – Before DCFS Involvement:

– SPIDER Resource Locator: spider.dcfs.illinois.gov– Family Advocacy Centers:

illinois.gov/dcfs/lovinghomes/families/Documents/Family_Advocacy_Directory.pdf– Division of Specialized Care to Children: dscc.uic.edu– Safe Families: safe‐families.org , safe‐families.org/locations– Community Mental Health Centers:

illinois.gov/hfs/MedicalProviders/behavioral/CommunityMentalHealthCenter/Pages/default.aspx– IDPH Opioid Use Treatment Resources for Pregnant Women with Medicaid in Illinois:

dph.illinois.gov/sites/default/files/publications/publicationsowhopioid‐use‐treatment‐resource‐manual‐ab.pdf

– Community Substance Abuse: illinois.gov/dcfs/brighterfutures/healthy/Pages/Substance‐Abuse‐Services‐and‐Assistance.aspx

– ILPQC Mapping Tool to map local resources: ilpqc.org/docs/toolkits/MNO‐OB/Opioid‐Use‐Treatment‐Mapping‐Tool_5.11.18.docx

– Illinois Opioid Assistance and Recovery Hotline (OARS): 1‐833‐2FINDHELP (234‐6343)– Illinois Women’s Health Hotline: 1‐888‐522‐1282– SAMHSA Treatment Hotline: 1‐800‐662‐HELP (4357)

4. Early Intervention Referral (IL Child & Family Connections), APORS Reporting

Official Referral to Early Intervention (IL Child and Family Connections)

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• IL Child and Family Connections serves families and children under the age of 3 with suspected developmental delays

• CFC provides a system point of entry into the IL Early Interventions System

• CFC provides service coordination of early intervention services including evaluations, connecting eligible families to therapies, community resources, and transition

IL Adverse Pregnancy Outcomes Reporting System (APORS)

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• APORS collects information on Illinois infants born with birth defects or other abnormal conditions.

• Purpose of APORS:– Conduct surveillance on birth defects– Guide public health policy in reduction of adverse pregnancy

outcomes– Identify and refer children who require special services to correct and

prevent developmental problems and other disabling conditions

• All licensed Illinois hospitals are required to report adverse pregnancy outcomes to APORS (Note: APORS also receives reports from St. Louis Hospitals part of So. IL Perinatal Network)

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Importance of AccurateReporting of NAS in APORS

• According to a study in 2019:– The incidence of NAS in Illinois in 2016 and 2016 was 3.0 cases per

1,000 https://www.cdc.gov/mmwr/volumes/68/wr/mm6807a3.htm?s_cid=mm6807a3_w

• IDPH APORS identified 944 infants with NAS, admitted to 110 different hospitals (2015 – 2016):– Only 27.1% of the cases were reported to APORS with NAS – An additional 61.0% of the cases were reported with drug exposure but

not NAS– 28.4% of babies with NAS were not reported to APORS with any drug‐

associated condition• This is a problem for statewide monitoring of NAS & also that families

could not be offered the services that might be of benefit to them

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Accurate Reporting of NAS IN APORS• IDPH/ILPQC: Accurate Reporting of NAS in APORS Fact Sheet:

– Fact sheet to provide guidance for APORS abstractors on accurate documentation of NAS in APORS

Accurately reporting NAS into APORS

Helping ensure newborns with NAS and their families are connected to IL

CFC/Early Intervention

Team Talks

How Many Social Workers Does it Take…

A Team Approach to Supporting Patients with OUD

Peggy Healy, LCSWJanet Winslow, LCSW

Perinatal Family Support CenterDr. Matthew Derrick, Neonatologist

March 18, 2019

Who We Serve

• Services provided to pregnant patients: north of Chicago to the Wisconsin border, at two hospitals– 3500 deliveries per year– Level III NICU with 42 beds

• High-risk obstetric clinic• Maternal Fetal Medicine group• Community based obstetric practices

Perinatal Family Support CenterProgram Overview

• Relationship based hospital care model serving approximately 1500 patients/year

• 9 Masters-level clinicians, equivalent 5.5 FTE’s

• In-house weekdays, 24 hour pager/phone coverage

Scope of Program• Psychosocial assessments, including

perinatal mood assessment for all referrals• Participate in perinatal consults• Referral to community based resources

(Illinois MOM’s hotline 866-364-6667)• Patient advocacy (mother and baby)• Interdisciplinary collaboration• Concrete services

Prior to Delivery

• Referrals from physicians when OUD has been identified

• PFSC Specialist assigned to each patient• Collaborate with treatment providers• Neonatology consultation

– Anticipatory guidance for evaluation and treatment of baby

– Birth planning– Safe discharge planning

At/After Delivery

• Toxicology screening (per hospital PerinatalDrug Screen Policy)– Maternal: urine– Baby: umbilical cord

• Neonatal Abstinence Scoring protocol– Observation on postpartum unit– NICU admission if medically indicated

NorthShore OEN Progress

Prenatal Consult prenatally (if possible) with a Neonatologist &

Perinatal Family supportBirth

Cord Toxicology Sent

Neonate sent to Normal Newborn (and Peds if mother discharged)

If Neonate NAS signs severe

ISCU and Pharmacological Care

Discharge with PFSC input re discharge plan

Observe 3‐5 days

Non–Pharmicological bundle

•Nursing education related to non‐pharmbundle and stigma bias training for ISCU Normal Newborn and Pedsnurses

• Simulation training for stigma and bias for the physicians

Discharge PlanningDCFS and/or internal High-Risk Infant Discharge agreement

• Ongoing assessment of parental involvement in care of infant, adherence to treatment, maternal mental health assessment

• Determine need for DCFS reporting vs High-Risk Discharge

• Facilitate multi-disciplinary family meetings• Provision of resources, ongoing support to

facilitate transition after discharge

Recommendations for Best Practice

For Unit-Based Care Models

Develop work-flow to identify stakeholdersfrom pregnancy to baby’s discharge

– Identify patients with OUD during pregnancy– Warm hand-off between unit social workers to ensure

continuity of care– Ongoing documentation of assessment, treatment, and

discharge planning – Develop materials to educate mothers/families about

perinatal mood disorders

Emily Johnson, LMSWNICU Social Worker-SSM Health Cardinal Glennon

St. Louis, MO

Process for Social Work Involvement

• Reminders / disclaimers • Reality vs. expectation of discharge• Referral for SW assistance or involvement • Consult with family• Call to MOCD / ILDCFS• Contact with MOCD / ILDCFS investigator • Establishing a safe discharge plan

Receiving Referral

• OSH • Drug screen obtained • Concerns regarding behavior or prior history • Communication with SW and medical team

• Urine, Meconium and umbilical drug screens• Urine: must be first void • Meconium: sending enough; waiting for transition • Umbilical: sending with prior history, current or past use or

concerns

Consult with Family

• Importance of level of detail gathered• Discuss NICU SW role• Obtain current demographics• Talk about medical needs and concerns with baby

• Progress and needs• Discharge plan and process

• Discussion of social history• Drug use: current, past• Involvement (current or past) with MOCD / ILDCFS• Other social concerns: homelessness, limited resources, mental illness,

limited functioning, addiction, treatment, etc…• Treatment

MOCD/ILDCFS Involvement

• OSH hotlined• CG SW to hotline • Work with investigator ongoing (long term vs. short term)

• Difference with 25 wk. vs. 38 wk.• Discuss concerns or needs as discharge approaches• Affidavit • ILDCFS to petition the court or discuss other options or

level of involement• Discharge plan for safe placement

Affidavit

• Documentation of needs and concerns• Expressing concerns with discharge plan• Concerns of discharge with safe plan or no treatment in

place• Submit directly to court and to MOCD / ILDCFS

Safe Discharge

• ILDCFS involvement• Contact with family• Home visit• Considering risk or other concerns • Parent(s) in treatment• Drug testing

• Petitioning the court• ILDCFS

• Taking custody at time/day of discharge• Placement • Discharge

• Services in the home• Follow up once discharged

Success in Discharge Planning

Successful• Team approach• Open communication

– Medical team– MOCD / ILDCFS

• Willing to work with the hospital• Understanding of hospital

constraints • Supporting the family: Resources• Actively working the case

Emily [email protected]

MNO QI Corner

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Quality Improvement Tools

Past Tools and Resources:• 30/60/90 day plans• PDSA Worksheets• Process Flow Diagrams

– High Level– Detailed

• Inner‐Rater Reliability– A performance measurement tool that

compares responses (RN scores on ECS) against a standard (a Super User RN) to determine the validity* of the assessment (ESC).

PDSA Worksheet

*The tool measures what is aims to measure

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Quality Improvement ToolsUsing QI to implement a “ILPQC Coordinating a Safe Discharge Checklist:”• Review at MNO‐Neo QI team meeting to identify what areas

are not currently being implemented/in place and create 30/60/90 day plans

• Create process flow for your individual hospitals discharge guidelines for all providers and staff to reference

• PDSA‐ Test with 1 nurse, 1 provider for the first patient with NAS, discuss, adjust accordingly, retest

• Create a safe discharge simulation for hospital providers and staff or use the ILPQC Eat Sleep Console Simulations and practice filling out a safe discharge plan for one of the cases with hospital providers and staff

Team Support for MNO-Neo Teams in 2019• REDCap Reports Overview and Using Data to Drive QI Webinars for teams coming soon

• Developing Stigma & Bias training modules from the Stigma & Bias Plenary and Neo Breakout session at the Annual Conference‐ Available for teams SOON!

• Developing Eat Sleep Console simulation training modules from the Neo Breakout session at the Annual Conference‐ Available for teams SOON!

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Upcoming MNO-Neo Teams Calls

Date Topic

April Empowering mothers to participate in their newborn's care

May Nutrition and Breastfeeding + Face‐to‐FaceMeeting

June –December

To Be Determined

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2019 FACE-TO-FACE MEETING

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FACE-TO-FACE REGISTRATION OPEN!

Visit www.ilpqc.eventbrite.com to register today!

Storyboard Template for 2019 Illinois Teams

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• Storyboards must fit into a space approximately 28 x 40 inches. It may be created from a collection of letter‐sized sheets (print outs of your power point slides or word documents) that are convenient for carrying while traveling. About six 8x10 inch sheets can fit in the available space. Large post‐it sheets and tape will be provided at the meeting.

• Share your story: about your hospital, about your team, describe your goals for this initiative, include process flow diagram draft, can include any barriers you have identified and opportunities for improvement, describe next steps or action items for your team

• Keep it simple: the Storyboard is not meant to be an extremely time‐consuming project.

Display Tips

• Be creative‐ there is no wrong way!

• Use fewer words and more pictures and graphics

• Include photos, collages, and illustrations (including a photo of your team)

• Use the largest font size as possible for readability

• Use color to highlight key messages (If you don’t have a color printer, use bright highlighters)

• Clear titles and labels if you use graphs (X and Y axes, dates, brief explanation of what it shows)

Storyboard Instructions

Storyboard Instructions:Participating in Multiple Initiatives? • Your hospitals may be participating in multiple OB & Neonatal

initiatives at in 2019. We encourage teams to bring one OB and one NEO storyboard addressing the active initiatives they are participating in:

• OB Teams:

• MNO‐ OB

• IPLARC Wave 1 or 2

• Neonatal Teams:

• MNO‐ Neonatal

• Describe your hospital and demographics

• List team members and their roles (add a team photo if available)

• List identified barriers and strategies for addressing them across initiative

• Describe any PDSA cycles and their results

OB & Neonatal Teams Shared Content

Initiative Specific Content• MNO‐OB:

• Process flow for OUD protocol

• Progress on structure measures and key process measures including MAT at delivery and OUD clinical care checklist in chart

• MNO‐Neo:

• Process flow for OEN protocol

• Progress on structure measures and key process measures including breastfeeding, pharmacologic treatment, and safe discharge

• IPLARC/IPAC:

• Wave 1: Include information about comprehensive contraceptive counselling & documentation (prenatally and on L&D), process flow, and GO LIVE date.

• WAVE 2/IPAC: Include team goals, next steps, draft process flow, 30‐60‐90 day plan‐where are you starting, what do you want to accomplish next?

Example: Team participating in 2 initiatives

Hospital Name

Neo MNO QI Team

Composition

Hospital Demographics

MNO-Neo MNO-Neo

Identified MNO-Neo

Team goals and

successes

30-60-90 Day plan

Hospital OEN process flow

Identified barriers &

strategies to address Safe Discharge

Process and LOS data

Non-pharm care

strategies

Process flow for non-pharm

and pharm carePictures/data

sharing

Sample Layouts

With 4 portrait oriented sheets in the middle panel

With 3 landscape oriented sheets in the middle panel

THANKS TO OUR

FUNDERS

Date post:	22-Sep-2020
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